小児閉塞性睡眠時無呼吸症候群の9歳双生児における急速上顎拡大術とアデノトンスルレクトミー：学際的努力

Rapid Maxillary Expansion and Adenotonsillectomy in 9-Year-Old Twins With Pediatric Obstructive Sleep Apnea Syndrome: An Interdisciplinary Effort.

抄録

小児閉塞性睡眠時無呼吸症候群は神経認知の問題を引き起こすことが知られているが、しばしば発見されなかったり、誤った治療がなされたりする。著者らは、いびき、扁桃肥大、日中の過度の眠気を有する9歳の双子について述べている。受診時、歯科医は、患者が中顔面欠損で症状があることを発見した。歯科医が処方した自宅での睡眠検査では、無呼吸低呼吸指数がそれぞれ74/hと16/hであった。小児は耳鼻咽喉科医に紹介され、持続陽圧呼吸療法を試した結果、認知と気性が改善した。その後、歯科医院で急速上顎拡大術が行われ、耳鼻咽喉科専門医による腺扁桃摘出術と言語聴覚士による筋機能リハビリテーションが両患者に行われた。治療後、無呼吸低呼吸指数は0.9/hと1.6/hと大幅に減少し、持続気道陽圧試験中に報告された結果を模倣した。この症例は、小児閉塞性睡眠時無呼吸症候群管理の学際的性質と、適切な診断と治療のためにすべての医療専門家が包括的な睡眠医学トレーニングを受ける必要性を強調している。

Pediatric obstructive sleep apnea is known to cause neurocognitive problems, yet it often goes undetected or mistreated. The authors describe 9-year-old twins with snoring, enlarged tonsils, and excessive daytime sleepiness whose symptoms had been previously disregarded by health care professionals. At presentation, a dentist found the patients to be midface deficient and symptomatic. A home sleep test, prescribed by the dentist, revealed apnea-hypopnea index readings of 74/h and 16/h, respectively. The children were referred to an otolaryngologist, and a continuous positive airway pressure therapy trial resulted in improved cognition and temperament. Rapid maxillary expansion was then performed at the dentist office, followed by adenotonsillectomy by an ear, nose, and throat specialist and myofunctional rehabilitation with a speech pathologist for both patients. After treatment, results mimicked those reported during the continuous positive airway pressure trial, with substantially reduced apnea-hypopnea index of 0.9/h and 1.6/h. This case highlights the interdisciplinary nature of pediatric obstructive sleep apnea management and the need for all health care professionals to receive comprehensive sleep medicine training for proper diagnosis and treatment.